Health minister attacks dental health protection

Fluoridation of community water supplies is under attack by the new health minister, despite its success in Israel in reducing dental caries in children

By T. TULCHINSKY, J. MANN, H. SGAN-COHEN

May 19, 2013 20:39

4 minute read.

Dentists Chair 370.
(photo credit: Wikimedia Commons)

Fluoride is an element naturally present in water, and at specific levels
improves dental health.

However, fluoridation of community water supplies
is under attack by the new health minister, despite its success in Israel in
reducing dental caries in children, with important health benefits especially to
poor and middle class population groups. When economic cutbacks are threatening
to worsen the situation of the poor in Israel, the minister, and the government,
should reconsider and retract her act to stop this important public health
measure.

Fluoridation when implemented by the ministry was challenged
legally, but supported by the Supreme Court. Unfortunately the minister
apparently believes non-facts and total distortions. As one example, the
minister claims that fluoridation causes cancer. This is untrue. Israel has had
fluoridation for much of the population since 2002. Data from the World Health
Organization European Region shows the total standardized cancer mortality rate
in Israel is low compared with those of Ireland (fluoridated since the 1960s),
Netherlands (not fluoridated) and the UK (limited fluoridation), and has
declined steeply in the past decade.

In July 2011, the American Public
Health Association reported: “Health advocates fighting myths about fluoridation
with science: Misinformation endangers oral health. Dental advances over the
past six decades mean that many Americans do not remember a time when tooth
decay and disease was a major national public health problem. But in the 1940s,
more than 15 percent of World War II recruits were denied the ability to enlist
in the Army because they lacked six pairs of opposing teeth. The adult human
mouth contains 32 teeth, and yet just 70 years ago a large number of 21- to
35-yearolds did not have even 12 good teeth.”

Much of the credit for the
nation’s better oral health can be attributed to the decision in the 1940s to
begin adding fluoride to public drinking water systems. According to the
American Dental Association, fluoridation reduces tooth decay in all age groups
by 20% to 40% “even in an era with widespread availability of fluoride from
other sources, such as fluoride toothpaste.”

In April 2013, the US
Surgeon-General, Dr. Regina Benjamin, officially endorsed community water
fluoridation, stating that, “Fluoridation’s effectiveness in preventing tooth
decay is not limited to children, but extends throughout life, resulting in
fewer and less severe cavities.... In fact, each generation born since the
implementation of water fluoridation has enjoyed better dental health than the
generation that preceded it.”

Every surgeon-general for the past 50 years
has endorsed fluoridation of community water supplies as a safe and effective
weapon in the war against tooth decay.

The minister met with senior
medical and dental professionals from the ministry and academia on April 8,
2013, along with a number of nonmedical anti-fluoridationists. All the
medical-dental participants strongly supported fluoridation. The minister was
given a detailed report of a nation-wide survey conducted by one of us (HSC),
which clearly showed the effectiveness of fluoridation, particularly in poor
communities.

The minister raised her view that the state should not
impose on people the level of fluoride in the water.

Several days later
she signed a decree that can potentially cease fluoridation in Israel within a
year. Her libertarian view has been refuted by leading ethicists, and by the
Supreme Court.

In nature there is no water without fluoride, but the
level varies widely and there is no basic right for any specific level. No
person has the right to deprive large, vulnerable parts of society (such as
children) of the beneficial effect of the fluoride.

The minister
expressed concern about that only a small fraction of the fluoridated water is
used for drinking; the majority is used for anything from washing clothes to
irrigating vegetables. She seeks other ways to achieve the same effect, but the
accumulated evidence of many decades, as stated by the US surgeongeneral, shows
that fluoridation of community water to a specific level is the safest and most
cost-effective method to prevent dental caries and its painful consequences and
achieve better dental health for the nation.

It is the responsibility of
the health minister and the government to use the best dental, medical and
public health professional judgments from within the ministry and
academia.

The professional support for fluoridation by leading medical,
dental, academic and public health authorities should convince the minister to
maintain our achievement in this field. Fluoridation is safe and costeffective
in preventing poor dental health and improves the health of our children and
adults, especially the poor.

Ted Tulchinsky is an associate professor,
Braun School of Public Health, the Hebrew University-Hadassah, Jerusalem.
Jonathan Mann is a professor and chairman of the Department of Community
Dentistry, Hadassah Medical Center. Harold Sgan-Cohen is a professor, Department
of Community Dentistry at the Hadassah Medical Center.

Elliot M. Berry is
a professor and head of Department of Human Nutrition and Metabolism and
director at the World Health Organization Collaborating Center for Capacity
Building in Public Health, Braun School of Public Health at the Hebrew
University-Hadassah, Jerusalem. Rifaat Safadi is a professor and director of the
Liver Unit at the Institute of Gastroenterology and Liver Diseases, Division of
Medicine, Hadassah Medical Center and Ronny Starkshall has a PhD from the Braun
School of Public Health and Community Medicine.

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